INFORMATION RELEASE FORM

Enrollment Services | Financial Aid | Disability Access Services

Under the Family Educational Rights and Privacy Act of 1974 (FERPA) Students have the right to release or not release information contained in their student record. Information contained in the student record will not be released without written consent of the student with the exception of directory information. Prospective employers, creditors, parents, or other interested parties must obtain a signed release from the student and submit it to the Enrollment Services | Financial Aid | Disability Access Services at the time of the request.

Separate signatures are required for each office that the Information Release Form is requested.

First Name

Last Name

ctcLink Identification Number

Address

City

State

Zip Code

Phone

Financial Aid and/or Business Office

I authorize the Financial Aid and/or Business Office at Skagit Valley College to discuss confidential account information for the purpose of understanding and meeting college-related financial obligations with me (the student) as well as the person(s) listed on this form.

I understand the person(s) listed on this form will have access via phone, in person or by mail to information that may include the following:

• My financial aid and scholarship records, including processing and eligibility status, as well as award types.
• Specific student and parental income or asset information.
• College tuition billing account and statements, including credits and debits posted to that account and any refund amounts I may receive.

This authorization does NOT allow the college to release specific academic information that is not directly related the the student's financial aid account or financial aid eligibility.

Name

Relationship to Student

Authorization Password*

Name

Relationship to Student

Authorization Password*

Name

Relationship to Student

Authorization Password*

*Please limit the password to one printed word. The authorized person(s) will be expected to know this information.

Disability Access Services

The Disability Access Services (DAS) at Skagit Valley College is committed to ensuring that all information and communication pertaining to a student’s disability is maintained as confidential as required or permitted by law. If a student wishes to have information about their disability shared with others, the student must provide written authorization to the DAS coordinator to release the information. Before giving such authorization, the student should understand the purpose of the release and to whom the information is being released. The student should also understand that there may be occasions when information will be shared regarding a student’s disability at their discretion if circumstances necessitate and the Coordinator has determined that there is an appropriate legitimate educational interest involved.

Name(s) of people to release information to:

I understand that entering my first and last name below, and submitting this form, constitutes a legal signature. All authorizations for release of information are effective only for the academic year in which they were submitted.

I acknowledge that the above information was completed and submitted solely by the student referenced in this release and that this consent my be revoked at any time upon written request.

Electronic Signature

*This consent may be revoked at any time upon written request.

Date

Effective for current academic school year.

Source

Address, Phone	Placement
Date of Birth	Degrees Awarded & Major
Enrollment	Name
Transcript Information (Grades)	Tuition/Fees Account Balance
Veteran Status

Address, Phone	Placement	Date of Birth
Degrees Awarded & Major	Enrollment	Name
Transcript Information (Grades)	Tuition/Fees Account Balance	Veteran Status